The  autism spectrum disorders  are a set of different neurodevelopmental disorders linked to abnormal brain maturation that already begins in the foetal stage , long before the birth of the child. The disorder occurs in a very variable way from case to case, but in general it is characterized by impaired communication and social interaction and the presence of restricted and repetitive interests and behaviours. In the past, autism spectrum disorders, due to the great variability from child to child, were variously called : 
 

– Different subtypes referred to in the past, for example, with the term “Autistic Disorder”;
– Asperger’s syndrome;
– Generalized / Pervasive Developmental Disorder not otherwise specified;
– High-functioning Autistic Disorder.

Today it is estimated that at least one in 100 children have an autism spectrum disorder. 

WHAT ARE THE CAUSES:
To date we do not know the exact causes that lead to autism even though research has made significant progress? For example, we know of many  genetic alterations  that are linked to autism spectrum disorders. It is likely that these genes can interact with each other and with the environment causing autism.
It is now widely demonstrated that the  causes of autism  spectrum disorders are not attributable to either educational errors or family conflicts.
Autistic children are born with this disorder and parents bear no responsibility for it.

WHEN AND HOW IT HAPPENS:
The development of social and communication begins at an incredibly early age. In fact, from the earliest stages of development, the child is actively engaged in interacting with the surrounding environment. Signs of a correct socio-relational development can be:    

– The first smiles;
– The first intentional gestures (among all the gesture of pointing, which appears between the first and second year of life).

The development of intentional gestures accompanies and often precedes that of language. The first words begin to emerge normally around the first year of life and around 18 months the first combinations of words appear. Autism Spectrum Disorders typically occur in the early years of a child ‘s life . Parents are usually the first to realize their baby’s difficulties as early as 18 months. In very mild cases this can happen even after 24 months. In some children, the parents report apparently adequate development up to 18 months, followed by an arrest and a regression of already acquired skills. The first alarm bells are usually: 
 

– Communication and socialization problems. Children with autism spectrum disorders first manifest difficulties in non-verbal communication: they do not look into the eyes and avoid the gaze, they seem to ignore the facial expressions of mom and dad and do not seem able to use facial expressions and gestures to communicate, they have poor interest in others and their activities, little interest in other children, etc.


– Presence of stereotyped behaviours such as an excessive interest in some objects or parts of objects, an excessive attachment to routine behaviours, the presence of always the same and repeated gestures of the hands and body.

HOW THE DIAGNOSIS IS DONE:
The diagnosis is “clinical”, i.e., based solely on the observation of the child . In other words, there are no laboratory or imaging tests ( CT , magnetic resonance , etc.) able to confirm the diagnosis. It is therefore advisable to rely on specialized health structures and a multidisciplinary team , made up of Child Neuropsychiatrist, Psychologist and Speech therapist. The team will be adequately prepared for a comprehensive clinical evaluation of the child. Specific tests are performed that are useful to help doctors in finding the diagnosis:   

– The ADOS-2 (Autism Diagnostic Observation Shedule-2nd Edition);
– The ADI-R (Autism Diagnostic Interview-Revised).

The first test is based on game observation while the second test is an interview collected by parents to investigate the presence of   autism spectrum symptoms . In the diagnostic phase it is essential to investigate, in addition to the symptoms related to autism, the cognitive functioning, adaptive behaviour and linguistic abilities of the child.

HOW THE TEST IS CARRIED OUT:
The meetings with the child are aimed at assessing the presence of symptoms typical of an autism spectrum disorder as well as the child’s cognitive, adaptive, and linguistic skills and the possible presence of associated mental illnesses . Through meetings with parents, information on the child’s behaviour is collected and the early stages of life and growth are reconstructed . This is how the period of acquisition of the stages of psychomotor, linguistic, and social development is defined. 
 

HOW TO TREAT IT:
Once the diagnosis is defined, it is necessary to plan an effective rehabilitation intervention . The developmental stage and diversity of each child with autism spectrum disorder must always be considered in the choice of therapy. In 2011 the Institute Superior of Sanità drew up a Guideline for the Treatment of autism spectrum disorders in children and adolescents. The most effective treatments are: 
  

– Structured psychological and behavioural programs (Applied Behavioural Analysis – ABA, Early Intensive Behavioural Intervention – EIBI, Early Start Denver Model – ESDM) aimed at modifying the behaviour of the child to favour a better adaptation to daily life;
– Interventions mediated by parents: parents are guided by professionals to learn and apply the most suitable methods of communication in everyday life to favour the development and communication skills of the child.

We can define an intervention as appropriate when:  

– It is early (within 2-3 years);
– It is intensive (20/25 hours per week of learning opportunities in which the child is actively involved in psychoeducational activities that are planned and appropriate to his level of evolution, distributed in the different contexts of life: therapy centre, family, and school);
– It provides for an active involvement of the family and the school;
– It is characterized by a constant measurement of progress.

WHAT IS THE MOST SUITABLE BEHAVIOR:
Given the specificity of the symptoms presented by children with Autism Spectrum Disorder, it is useful to adopt interaction strategies that adapt as much as possible to their interaction and communication difficulties. In fact, it is useful to keep in mind some precautions when interacting with your child :  
 

– Maintain a posture that favours eye contact and face-to-face interaction;
– Follow the child’s interest to try to involve him in shared activities;
– Speak in simple language, suited to the child’s language skills.

For parents it can be useful, especially in the early stages after diagnosis, to undertake a path of Parent Training or Parent Mediated Therapy to promote a correct way of interacting with the child.  

Source: www.ospedalebambinogesu.it/autismo-sindrome-autistica#.X9ZsjDjPyHs

WHAT CAN KARATE DO?

Let us look at some case studies, where karate training has benefited people with autism.

Using the kata (forms) of karate to reduce stereotypical behaviour. Training in Kata techniques consistently reduces stereotypy in children with autism spectrum disorder (2012).

By Fatimah Bahrami, Ahmadreza Movahedi, Sayed Mohammad Marandi and Ahmad Abedi.

As mentioned, stereotyped behaviours are common in autistic people and can often be problematic. They are repetitive movements of the body or repetitive movements of objects. Examples include simple body movements, such as swinging and flapping arms, walking up and down, constantly aligning toys, or even self-injurious behaviour. Different types of exercise have been shown to reduce stereotypical behaviours of autistic people. 

A more frequent and more strenuous exercise seems to have a more incisive effect, considering the person’s potential. This project studied the impact on 30 children with ASD (Autism Spectrum Disorders) for a period of 14 weeks of studying Kihon (basic movements of karate) and kata (form), four times a week – 56 sessions in total. 

A significant reduction in the stereotypical behaviour of children was found. The document provides an incredibly detailed description of how the lessons were structured and managed and a summary lesson plan for each of the 56 sessions. Explain that the kihon combinations started out simple and developed during the training course. The kata was broken down into small segments and rebuilt again over the weeks. The paper also suggests a reason why karate training has worked so well. 

He proposes that kihon and kata are themselves a stereotypical type of behaviour and can create the same sensory feedback and / or brain activity for individuals with ASD and return the child to a state of balance. A point to consider is that the children were not taught any martial application of the kata, only the form itself. Interestingly, after 30 days of inactivity, stereotypy in the group remained significantly reduced compared to the pre-intervention time.

Using karate kata to improve the social skills of autistic children. Improvement of the social dysfunction of children with autism spectrum disorder after training in long-term Kata techniques (2013).

By Ahmadreza Movahedi, Fatimah Bahrami, Sayed Mohammad Marandi and Ahmad Abedi.

The finding of this study is that Kata training for autistic children led to a significant improvement in their social interaction, another common challenge for autistic people. Like the previous study, they provide detailed instructions on how the lessons were structured and managed, which would be useful for anyone looking to develop their own program. 

This time they do not include a summary of the lesson plan, but reading between the lines, we could assume that the contents of the lessons were quite like the first study. The team suggests several possible reasons why karate training could have been so effective: The training provided autistic children with many potential structured social interactions. 

Children may have benefited from observing and copying their peers during the practice. The lessons may have helped the children learn basic concepts such as proper etiquette for addressing the instructor, lining up for class, and even socializing. Children perform the same group techniques. This gave them the opportunity to participate together following identical routines. 

The article also examines in detail the neurochemical changes that might occur in students’ brains while practicing kata and how these might improve social dysfunction. Interestingly, at one month of follow-up, the improvement in social deficiency in the exercise group remained unchanged from post-intervention time. 

The social deficiency of the participants in the control group was not changed during the experimental period. It was concluded that teaching martial arts techniques to children with ASD leads to a significant improvement in their social interaction.

Using karate kata to improve communication skills of autistic children. The effect of karate training on the communication deficit of children with autism spectrum disorders (2016).

By Fatimah Bahrami, Ahmadreza Movahedi, Sayed Mohammad Marandi1, Carl Sorensen.

In this study it was found that teaching Karate to children with ASD led to a significant reduction in their communication deficit. Like the other two studies, this one contains useful details on how they conducted the 14-week course for young people.

For example: The initial duration of the exercise session was 30 minutes, which was progressively increased to approximately 90 minutes in the first 8 weeks and remained at that duration for the remainder of the intervention (i.e., weeks 9-14). The 90-minute sessions were divided into the following activities: warm-up (15 min; 10 min of stretching, 5 min of jogging), adapted karate instruction (65 min) and cool down (10 min). The adapted Karate instruction portion of each session was further divided into 1: 1 instruction followed by synchronized group practice.

 […] During the warm-up and cool-down parts of each session, pre-recorded Persian music was provided in the exercise area. We have progressively used motivational techniques, systematic reinforcement, and stimulation strategies, including verbal exhortations, evaluations, and rewards to keep the participants of the experimental group motivated to continue training and bring them closer to the experience […] Parents of the participant in the exercise group they were present during the training sessions and we used their assistance when a child was not obeying the rules or expectations. We usually let the child stand alone in a separate room with his interests and try to bring him back to his normal state of mind.

Again, the paper also includes a detailed section on the authors’ theories as to why Karate had such a huge effect on children, in terms of its effects on their brains. Furthermore, the reduction in communication deficit in the exercise group at one month of follow-up remained unchanged with respect to the post-intervention time. It was concluded that teaching Karate techniques to children with ASD leads to a significant reduction in their communication deficit.

The practice of karate can directly improve the psychophysical well-being of people with ASD. The achievement of gradual and progressive goals goes hand in hand with the small and big successes that people with autism can obtain and is certainly a great incentive to increase self-esteem and strengthen confidence in their own means and potential.

Scientific insights : www.researchgate.net/profile/Fatimah_Bahrami